Dark Circles – Eye Rejuvenation

Dark Circles, At A Glance

  • Best Results1-5 sessions, variable results
  • Treatment RecoveryImmediate
  • Procedure Time10- 30 minutes
  • Skin SpecialistDavin Lim, Nurse
  • Duration of ResultsVariable
  • AnaestheticNumbing
  • Back to WorkImmediate
  • Cost$-$$

Dark Circles - Eye Rejuvenation

This common skin concern is one of the most complex entities dermatologists deal with as there are many causes of dark circles. In some cases, treatments can be straight forward – dermal filler is an example. In others, it is complex, namely exclusion of allergens & irritants. Read more for an accurate guide as to how I approach dark circles– understanding the causes will lead to effective solutions.

FactsFacts on Dark Circles

  • Dark circles can be due to over two dozen skin conditions
  • Most patients will have at least two associated causes of dark circles
  • A directed approach addressing the cause will give better results than ‘tying’ treatments
  • Lasers including pico & dermal toning can reduce pigment
  • Dermal fillers can address deep tear troughs
  • Creams can be marginally effective for treating vascular & pigment causes
  • Caffeine, peptides, vitamin K & arbutin are actives to look for in skin care
  • In some cases, allergy testing via a medical dermatologist is required

What causes dark circles?

There are many causes of dark circles including genetic, physiological, post-inflammatory, age related laxity, anatomical, vascular, & in most cases a combination of the above. Treatment is aimed at addressing the actual cause.

What treatments are available?

In many cases treatments can help improve skin quality, volume, and integrity of the upper and lower eyelid skin. This, in turn, can improve dark circles and shadowing. I employ dermal fillers, lasers, surgery, energy devices and in some cases topicals to address various causes.

How can dermal fillers help?

Dermal fillers can hide shadows from a deepened tear trough. Fillers do not change ‘pigmentation’.  In cases whereby troughs are anatomically suitable, dermal fillers consisting of hyaluronic acid can help. In some cases, building up the support of the lower eyelid – eye bags can help hide dark circles. This involves dermal fillers to the rim of the eye before actually treating the trough itself.

I normally perform 2 sessions, separated by at least a week. The first is to build support, the second is to add volume to the deep troughs.

I use cannula technique in this area. Treatments are comfortable with little downtime. It is important to stop any potential medications that may cause unwanted bleeding or bruising during the filling process. This includes fish oil, high dose vitamin E, aspirin and anti-inflammatories. You should avoid exercise of 48 hours post dermal fillers.

In the context of ‘dark circles’, dermal fillers can give a 25-30% ‘correction.’ More on how I perform this procedure in the dermal filler section of this website, under ‘tear troughts.’

How can laser resurfacing help?

Lasers including Fraxel & LaseMD fractional resurfacing, CO2 & erbium can help in some cases of dark circles related to poor skin texture and/or skin laxity.

Skin type 1-2 (fair skin patients) respond the best. Lasers work by tightening skin through remodelling of collagen & elastin, in addition to removing sun damage (elastosis).

For darker skin patients (skin type 3+), my go to devices include pico lasers & RF energy devices.

Remember, lasers and energy devices only tighten. Volume replacement can only be achieved with dermal fillers or fat transfer.

Treating Dark Circles- Davin’s Viewpoint

This is one of the hardest algorithms to understand as there are many causes of pigmentation. The most frequent clinical presentations include two, or more concomitant causes. The most important aspect of managing dark circles is to not make this condition worse, which commonly happens.

An accurate diagnosis is essential. For genetic causes, marginal improvements can be made by addressing any shadowing, especially a deep trough. Skin irritation such as itch due to atopic or irritant dermatitis should be addressed with avoidance of irritants & potential allergens. If the latter is suspected, simple patch testing-allergy testing by a medical dermatologist will reveal the culprit/s.

Lasers can be useful if there are pigment & or vascular causes. QSL & pico lasers can give some responses to secondary causes of pigment, such as post inflammatory hyperpigmentation & marginal improvements in cases of physiologic pigmentation. Simple vascular lasers such as pulse dye laser can treat vascular congestion, especially on the lower eyelid. Larger periorbital veins that can contribute to ‘blue skin’ can be treated with long pulse Nd Yag lasers.

I frequently perform dermal fillers for the tear trough area in individuals with a tear tough deformity (harsh word to describe). In some cases, filler is straight forward. In cases where there is volume loss, I build up the orbital area and mid cheek before trough filling. My go to filler is a low-density hyaluronic acid filler, however in patients with really thin skin I do use calcium hydroxyl apatite fillers in a hyper dilute solution to avoid Tyndall to the area.

In the context of fat transfer, I tend to avoid this area, even with nano-fat & adipose stem cells. Reason being that overcorrection is frequently seen. Fat is great for large volume deficits (over 10 ml), I do not like fat in the under-eye area mostly because it is not as malleable nor as predictable as HA dermal fillers.

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